Provider Demographics
NPI:1851091110
Name:TRIFAM BEHAVIOR AGENCY LLC
Entity Type:Organization
Organization Name:TRIFAM BEHAVIOR AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-249-7218
Mailing Address - Street 1:1320 SE FEDERAL HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3410
Mailing Address - Country:US
Mailing Address - Phone:772-249-7218
Mailing Address - Fax:
Practice Address - Street 1:1320 SE FEDERAL HWY STE 212
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3410
Practice Address - Country:US
Practice Address - Phone:772-249-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty